title: The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery.
abstract: BACKGROUND
  There is growing support for umbilical cord blood gas analysis (UCBGA) to be conducted at delivery. A recent study in a tertiary level obstetric unit found that universal UCBGA was associated with improved perinatal outcomes, but there is less evidence of benefit in lower-risk environments. In such settings, lactate analysis may be a suitable alternative.
  
  
  OBJECTIVE
  This study evaluated the introduction of universal UCBGA into a secondary obstetric unit and universal umbilical cord lactate analysis program into primary and secondary units.
  
  
  METHODS
  After education, universal UCBGA or lactate analysis was introduced into one primary and two secondary level obstetric units. Univariate and adjusted analysis assessed changes in UCBGA values and Apgar scores over the study period.
  
  
  RESULTS
  There were no significant changes in mean blood gas and lactate values at any centre following introduction of universal UCBGA or lactate analysis. However, there was at the primary level obstetric unit a significant reduction in the proportion of neonates with moderate to severe elevations in umbilical artery lactate values. There was a non-significant reduction in arterial pH values less than 7.10 at the secondary metropolitan centre.
  
  
  CONCLUSIONS
  The data presented in this study suggest that the benefits of introducing UCBGA into a tertiary obstetric centre may be reproduced in a primary obstetric centre within 12 months of implementation. Larger studies are required in secondary units to assess infrequent adverse obstetric and neonatal outcomes.
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Christopher R H
authors.initials: CR
authors.lastname: White
authors.forename: Dorota A
authors.initials: DA
authors.lastname: Doherty
authors.forename: John P
authors.initials: JP
authors.lastname: Newnham
authors.forename: Craig E
authors.initials: CE
authors.lastname: Pennell
mesh_terms: D000138:Acidosis / Q000175:diagnosis; D000328:Adult; D001034:Apgar Score; D001784:Blood Gas Analysis; D036861:Delivery, Obstetric; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D019344:Lactic Acid
keywords: acidaemia; blood gas analysis; implementation; perinatal asphyxia; umbilical cord